Provider Demographics
NPI:1760417315
Name:COLUMBIA BASIN CHIROPRACTIC CARE P.S.
Entity Type:Organization
Organization Name:COLUMBIA BASIN CHIROPRACTIC CARE P.S.
Other - Org Name:BRENT BEDFORD, D.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-754-3295
Mailing Address - Street 1:51 ALDER ST NW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1663
Mailing Address - Country:US
Mailing Address - Phone:509-754-3295
Mailing Address - Fax:509-754-3296
Practice Address - Street 1:51 ALDER ST NW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1663
Practice Address - Country:US
Practice Address - Phone:509-754-3295
Practice Address - Fax:509-754-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU63535Medicare UPIN